Health Maintenance Organization

You have been presented an
outstanding opportunity to serve as a graduate student intern for the chief
executive officer (CEO) of a large HCO. The HCO is an HMO model and originated
approximately a century ago as a small rural hospital. Due to the rural setting,
the HMO model flourished and, over the years, expanded throughout the region.
Today, the HMO has a presence in over eighteen counties and has a number of
competing interests from for-profit and not-for-profit HCOs in the region.

The board of directors recently
approved the acquisition of two regional hospitals. First, the HCO decided to
acquire a small rural critical-care-access hospital in a relatively remote
county. The interest in acquiring the hospital is to service the existing
population and expand the reach of the HMO. Second, the HCO decided to acquire
a private full-service hospital in a moderate-size city (population forty-two
thousand). The HCO’s move is strategic in nature, preventing the sale of the
hospital to its for-profit competitor, and will gain the region its sole
emergency department level 2 (two) trauma center with helicopter transport
while giving the HCO the ability to service its growing HMO membership in the
area.

Based on the above information:

• Evaluate the various HMO models (staff, group, and
  network) and identify the model that would probably be best suited for the
  region. Justify your answer.
• Research and comment on the importance and
  applicability of the various levels of emergency department trauma care.
  Investigate the exemptions afforded to a critical care rural hospital with
  respect to Medicare reimbursement and accreditation.
• Elaborate on the difference between an HMO and an
  accountable care organization (ACO).
• Explain the concept of capitation, its importance to
  the HMO and participating providers, and how the concept of capitation
  varies with the ACO model.
• Explain patient-centered care and its importance in
  healthcare delivery.

Submission Details:

• Submit your answers in a 2- to 3-page Microsoft Word
  document.
• Use scholarly resources within last 36 months.
• Cite all sources using APA format with in text
  citations on a separate page.

Assignment 3 Grading Criteria	Maximum Points
Commented on the importance and applicability of the various levels of emergency department trauma care.	10
Identified the HMO model that would be best suited in the scenario.	5
Outlined the exemptions afforded to a critical care rural hospital in regard to Medicare.	10
Identified the difference between an HMO and an ACO.	10
Explained the concept of capitation.	5
Presented a structured document free of spelling and grammatical errors.	5
Properly cited sources using APA format.	5
Total:	50